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hdr brachytherapy - a negative case

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Posted 9/9/2018 9:30 PM (GMT 0)
Bladder wall recurrence of prostate cancer after high-dose-rate brachytherapy.

Raleigh DR1, Hsu IC1, Braunstein S1, Chang AJ1, Simko JP2, Roach M 3rd3.
Author information
Abstract
PURPOSE:
Prostate cancer seeding after needle biopsy has been reported in the perineum, rectal wall, and periprostatic soft tissue. In this article, we report the results of a localized prostate cancer recurrence in the bladder following protrusion of a single high-dose-rate brachytherapy catheter through the bladder wall at the ultimate site of failure.
METHOD AND MATERIALS:
A 62-year-old man with high-risk prostate adenocarcinoma was treated with long-term androgen deprivation therapy, intensity-modulated radiation, and high-dose-rate brachytherapy boost. He developed biochemical recurrence 4 years after treatment, and a CT scan of the pelvis revealed a nodule in the posterior, inferior bladder wall.
RESULTS:
Surgical pathology following transurethral resection of tumor within the bladder was consistent with high-grade prostate adenocarcinoma. The patient's prostate-specific antigen level fell to the range of normal postoperatively, and whole body imaging, including a multi-parametric MRI of the prostate with diffusion and spectroscopy, failed to reveal any other sites of disease. Review of the CT scan obtained for dosimetry at the time of brachytherapy demonstrated a lone catheter protruding through the bladder wall at the site of eventual recurrence. The tumor recurred in the bladder 12 months later, once more without evidence of disease within the prostate itself or distantly, and the patient was started on salvage androgen deprivation therapy.
CONCLUSIONS:
This case is the first report of prostate cancer recurrence in the bladder wall after brachytherapy and raises questions about prostate cancer biology, brachytherapy technique, and the timing of brachytherapy boost relative to whole pelvic radiotherapy for prostate cancer.

Post Edited By Moderator (142) : 9/11/2018 9:46:39 PM (GMT-6)

Posted 9/9/2018 9:34 PM (GMT 0)
my wife calls this "borrowing trouble".

in fact she was the one who told me to to log off the prostate cancer forum and let her do the research when I was going out of my mind with fear and anxiety.
Posted 9/9/2018 9:45 PM (GMT 0)
Interesting, although I'm not sure how much we can extrapolate from one case. I'm assuming the number of guys that have had HDR brachy over the years is probably >100,000.
Posted 9/9/2018 9:59 PM (GMT 0)
Hmmm I hope so ..
Well hopefully this poor guy can get a lawsuit out of it probably not. I need to,stop I’m anxiety ridden now ...I had a bad feeling about this ....I remember when asking the stupid nurse about the procedure she said after the Caths are in go fir a scan to.make sure they r all in place not hitting the bladder ......now in going to go puke
Posted 9/9/2018 10:35 PM (GMT 0)
While I feel badly for any person that has a recurrence, unless there's proof the doctor was negligent, I strongly hope there is no lawsuit. Stuff happens. Every time I get in my car, I'm taking a risk. Every medical treatment has a risk. When I had my last treadmill stress test, what were the odds that I would have a heart attack? I don't know, but they weren't zero.
Posted 9/9/2018 11:16 PM (GMT 0)
I have looked at HDR\Brachy, but correct me if I'm wrong, but does this study not state that a catheter was protruding through the bladder, or am I way to tired right now? This isn't normal, correct? Pretty sure that this is the only case of this as I read the entire study which came out in 2014. So I'm confused by the subject line of your post.

Post Edited (ldog) : 9/9/2018 5:19:46 PM (GMT-6)

Posted 9/9/2018 11:41 PM (GMT 0)
Let’s hope did you read what I posted .its all a stinking guessing game and hoping ..sure they are hoping to put the Cath in the prostate but what if they miss ..oh shoot better do another study ...I’m crippled by all this
Posted 9/10/2018 12:16 AM (GMT 0)
https://profiles.ucsf.edu/i-chow.hsu Profile 80 publications how did I allow myself to do this
Posted 9/10/2018 12:53 AM (GMT 0)
Stan,
I’m thinking your anxiety is going to kill you before anything else. You can’t keep doing the same thing and expect a different outcome. I hope you can find a way to get yourself more settled.
Posted 9/10/2018 12:59 AM (GMT 0)
Interesting but is it an isolated case? I bet there are corollary examples from all main treatments. Accidents happen. Denis
Posted 9/10/2018 1:01 AM (GMT 0)
Catheters are placed like a fusion biopsy. They use a rectal ultrasound that is superimposed over MRI image. It is not a shot int he dark, very precise. Denis
Posted 9/10/2018 1:02 AM (GMT 0)
What happens if you go looking for information about problems? You find it. Stan, turn the computer off. Get offline. Start living. Seriously. You're out there doing the worst thing: looking for data to confirm your fears. And you'll find it. And you're convinced YOU are the 1% or 5% or 1 in a million case.

We can't help you. And you're not helping yourself. I'm inclined to put you on ignore...and I suggest others do it too.
Posted 9/10/2018 1:20 AM (GMT 0)
It just goes on and on and on and nothing is done about it.
Posted 9/10/2018 1:18 PM (GMT 0)
Stan: How many HDR guys on this forum experienced this rare outcome? Remember, a lot of the cases that go well are never posted here! That would leave the bad outcomes that you are referring to . . . do you see any?
Posted 9/11/2018 3:19 PM (GMT 0)
Stan, you are posting the same content on multiple forums under different names.
Posted 9/11/2018 7:02 PM (GMT 0)

Steve Smith said...
Stan, you are posting the same content on multiple forums under different names.


Appears he is on a mission to spread the word on the adverse affects of external beam radiation and Brachy therapy and how it will destroy your life.
Posted 9/11/2018 7:12 PM (GMT 0)
If that is his objective then he shouldn’t be here. I thinks the moderators have given him far too much leeway given his very negative suggestions regarding a very effective mainstream treatment method that has served thousands of men (many on this forum) very well.
Posted 9/12/2018 1:37 AM (GMT 0)

JNF said...
If that is his objective then he shouldn’t be here. I thinks the moderators have given him far too much leeway given his very negative suggestions regarding a very effective mainstream treatment method that has served thousands of men (many on this forum) very well.

Agree. Many of the posts "Stan" has made here can be found multiple times around the various cancer sites. "Stan" is the handle used here, and only here. Curious motive. Some people have too much time on their hands.
Posted 9/12/2018 3:45 AM (GMT 0)
Stan,

You are promoting one "bad" example as you try to find a reason that you are having issues.

I have no reason to believe that this case is representative of even a significant minority of treatments.
Your posts will leave new folks here questioning their choices. That can't be the case. We encourage members to consult with physicians and oncologists who have experience in PCa, and make their decisions based on their own research.

I respectfully request that you STOP the "sky is falling" posts.
Posted 9/12/2018 4:18 AM (GMT 0)
Steve, Moe, JNF,

If you suspect Stan (or anyone) of excessive cross-posting it would be helpful if you could provide one of the moderators with links. A certain degree of cross-posting is allowable when a user is asking the same question on multiple sites but can be abusive if so many copies are posted that it becomes clear that he is not trying to start conversations.
Posted 9/12/2018 9:25 AM (GMT 0)
Stan, get help for your anxiety. Trust me, help really works. What you're posting is not helpful to anyone, including yourself!
Posted 9/12/2018 1:06 PM (GMT 0)
How many posts due we have to endure before they shut it down?? rolleyes
Posted 9/12/2018 1:54 PM (GMT 0)
dbell (and others),

I can't shut down a thread unless a rule(s) is(are) broken. So far he is not doing that.

If anything, some replies border on Rule 3.

I hope he will realize that everyone has a different opinion about various type of RT, that he won't change our minds, but that he is creating doubt in newcomers that is not justified.
Posted 9/12/2018 9:40 PM (GMT 0)

moeskeeter said...

Steve Smith said...
Stan, you are posting the same content on multiple forums under different names.


Appears he is on a mission to spread the word on the adverse affects of external beam radiation and Brachy therapy and how it will destroy your life.

In that case, he should talk to me and others about what surgery can do for your life, things that are not rare events. I'm not at all certain he would prefer some of those unpleasantries(is that a word? SP?).

But Stan, I agree with those that say you have got to stop obsessing about this, the stress is likely to do you in way before the PC. I also agree with Halbert that if you go looking for trouble, you will find it.

You say a catheter went through a bladder wall? How about an epidural catheter(anesthesia) threading into a vein, with the potential(if not caught by an alert anesthesia provider) of causing maternal grand mal seizures followed by cardiac arrest and death of mother and infant? That is the kind of crap that can go wrong with almost any medical/surgical procedure. And I observed it go wrong in 1 case of a colleague during my 36 years in anesthesia. But that did not stop almost 10,000 of my epidural placements from keeping those Moms from screaming for 12-24 hours, all without bad outcome. And multiply my results times all the other anesthesia folks I worked with, except for that one fatality. Add a few close calls. But still maybe 75,000-100K women dodged a whole truck load of pain and agony(as the song says) for having taken that risk, just in this area alone. I think 99% of them would gladly take the risk again.

Stan, there is just nothing 100% safe in the medical world. But most of us take the chances because we find the alternatives worse. What about you? Is that the choice you made? If so, I am very sorry if you have drawn bad cards and it has not worked out as well as it could have. But I'm not sure at all what this one case report of the catheter going through the bladder wall tells guys who are trying to decide about BT. Like I said, surgery can have results that are no fun also, even if things go about as usual.

Walk away from all of this if you possibly can. I think you will be better off if you do.

Post Edited (BillyBob@388) : 9/12/2018 3:43:14 PM (GMT-6)

Posted 9/12/2018 10:11 PM (GMT 0)
I'm beginning to think Stan might be a urologist?
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